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HomeMy WebLinkAboutMiscellaneous - 2170 TURNPIKE STREET 4/30/2018 (2)u N_ O O � C7 :0 O Z O � co m 0 cn 0 m O m o m �LTJ- tLi H Lot & +'p Street % >` Map/Parcel r� C n I z' CONSTRU TION APPROVAL Has plan review fee been paid: YES NO Permit# Plan Approval: Date: lb �� Approved by: Designer:, . �.�� �gC� o Plan Date: 2A7D Conditions:/v6 Water Supply: Town Well Well Permit: Driller: Well Tests: Chemical Bacteria I Bacteria II Plumbing Sign -Off: Comments: Form "U" Approval: Date Issued Conditions: Date Approved Date Approved Date Approved Wiring Sign -off: Approval to Issue: YES By: Final Approval: All Permits Paid? YES NO Well Construction Approval? YES NO Septic System Construction Approval? YES NO Certification? YES NO Other? YES NO Any Variance Needed? YE NO e- f/)' Q p6'U 7-6 FINAL BOARD OF HEALTH APPROVAL: DATE: APPROVED BY: SEPTIC SYSTEM INSTALLATION CONDITIONS: Is the installer licensed? YES NO Type of Construction: NEW REPAIR New Construction: Certified Plot Plan Review YES NO Floor Plan Review YES NO Conditions of Approval from Form U YES NO Issuance of DWC permit: YES NO DWC Permit Paid? YES NO DWC Permit # Installer: Begin Inspection: YES NO Excavation Inspection: Needed: Passed: By: Construction Inspection: Needed: As Built PI n S tisfactory: YES: wl ��� o �' 13 t,— Approval of Backfill: Date: Final Grading Approval Date: iLaSLi� '� Y.LGLCJtW \�� By: By:/ Co Final Construction Approval: Date:. By: v -A) M KJkA-) Certificate of Compliance: Approval: Date: vd Z d o`' File Edit Tools Data Maintain Process View Report M Windows yelp Project: Billing Group ID: Billing Type: 111 Main 1h Billing info 11 Proposal Number: Contract Number: Contract Date: Work Start Date: Expected Finish Date: Description: 177'7''0--�--�� f 'Office of Health Department 27 Charles Street, No. Andover, Fixed Fee �_ Billing Fee: 300.0011 Card ID: ToNA Contract Info Classification GL Accounts Billing Messages Alerts Staffing Activities i ssign To= epartment: 14/11/02 I — — - - 1 Engineering services required for two bottom of excavation inspection Installer: John Whyman # 781-334-2323 Assessors Map 1086, Lot 8 Applicant: Lori Balboni 2170 Turnpike Road 0-1 Use Government Invoice Style h _Save Close dotes... Project Request Record Town of North Andover Date: -r-- Client Id: ToNA Card Id: ToNA Client/Company Name: Board of Health ,fid Card Type -Ghent f . !rlContactfName Ms' Sanri& Starr': Phone 978`688 Title Director 7 v rtev P/.� t lAddress Fax:° 9 77 &L 688 9542 27'Charles Street Email.:sstarr@townofnorthandover comp l' �/ .,Notes.,. i ;,Tooun North�A(ndover ('rjt' �+ tll ;+, it'`t' Sr,S'tate! ' MA Zip Code t 01'845 t+t ?` fi J/ Itlj ftf `, 7 f ri rf s!+ -:,r tr rr Other contacts`�f apphcatile ,ie Engineer taller fl11� Uji b It .. flr :iIrr rl�l�/l�si� aj:`.�� 1 r ,ft,tt ; k q", Name + 4/ r Phone: 11; ,€f - t 1 r I! S 1r ,j rt I1/tr #(f ,f Title' ` Fax, Entail: �F Notes: �,'tTown ,; =1PI ,', �f,t;i 1; ` f State Zip Code ;f /� rffAvf.ltll`',,f�=' Yi Proiect: Project Id: 1770 Project Title: Town of North Andover, Board of Health (JOB NO) (PROJECT NAME & STREET ADDRESS) Manager: NOW Billing Group: 631 Billing Cod : Fixed Fee S (2,0 Contract°.Info Project Descnptionf for each billing goup f P'{BG/te_, an QZ Assessors,lMap r���G Lot - .. Street / o 7 v rtev P/.� f ;Type, ofr service S -c7 �iw p T �.�Z O r �' f 1�✓/�� / i P t+; .t. Office/forms/jbrqutona n N & M Job number 1770/ TOWN OF NORTH ANDOVER INSPECTION CHECKLIST FOR SEPTIC SYSTEMS Installer: rJ4 /f O/ A--' /70" Y--7 Date A. Bottom of Bed jrf d Z- 1. Excavation to proper depth 2. With trenches, sides of excavation are beneath B horizon 3. Edge of excavation specified distance from foundation, etc. Comments: (Use back of sheet for diagrams.) B. Retaining Wall _ 1. Wall height and width as specified 2. Waterproofed 3. Wall minimum -16' o leaching facility 4. Bets specifications of plan Comments: Final Date: Yes Tel: %8/ — —z 3 z No Initials rlyarZ. ;77�-z� �C cy- v�3 C. Building Sewer 1. Pipe diameter minimum 4" 2. Schedule 40 pipe 3. Inlet to tank cemented 4. Slope minimum 0.01 or 1/ " er foot minimum --- 5. Pipe properly set o mpact firm base 6. Pipe laid on muous grade in straight line 7. Cleano precede all change in alignment e 8. M oles at any 900 change 9. 10' minimum offset to water line Comments: D. Septic Tank-� 1. Level 2. 3. 1,5 1 minimum as ba outlet present on 4. anhole to w/in 6" of grade Qom, 5. Manholes over center and each tee 6. 3-20" manholes An - 7. Cutlet line cemented 'CQ,����-r�� 8. 211- 3" drop from inlet to outlet 9. Pipe set 10. Compact base with 6" of '/4" crushed stone under tank 11. Tank is watertight 12. Tees 12" off side of tank r N & M Job number 1770/ Date Comments: E. Pump Chamber 1. If separate from tank, compact base with 6" of/e" 2. Minimum 2" pipe to d -box if gravity system 3. 20" access manhole 4. Tank Ievel 5. Watertight 6. Tank size agrees with plan sp ' cation 7. Manhole to grade 8. Check valve and bleedsZoleresent 9. Alarm in building orY�eparate circuit s 10. Alarm function 11. Manual operating switch 12. Pump delivers liquid to d -box Comments: F. Distribution Box 1. D -box level 2. Minimum 0.1 T' (2") drop from inlet to outlet 3. Minimum 6" sump 4. Outlet pipes show equal distribution 5. Compact base with 6" of stone beneath box 6. Box is watertight 7. All lines cemented with hydraulic cement 8. Schedule 40 pipe 9. First 2' from box laid level Comments Yes No Initials G. Soil Absorption system 1. All stone double -washed — 3/a" — 1 '/2" - pea stone Bucket test done? 2. Minimum 2" of pea stone above distribution lines 3. Minimum 6" stone beneath pipe 4. Distribution lines capped or connected together 5. Toe of slope stops minimum 5' from edge of property; 5a. if not, then swale. Comments: F N & M Job number 1770/ Date H. Leach Trenches 1. Minimum 2 trenches 2. Length of trenches agrees with plan. (Max. 3. Width of trenches agrees with plan Mii� 4. Vent present if>50 feet or specie- 5. Minimum distance betweenir-enches 10' 6. Pipe slope minimu .005 or 6" per 100' 7. Depth of tre s below outlet invert minimi S. Pipes set on stable base. Comments: Yes No Initials 1100') maximum - 4'. �- I. Leach Field A667 �-- 1. Maximum length of field 1.0' 2. Pipe slope minimum 0.005 or 6" per 100' 3. Separation en ipes 6' maximum 4. Pip connected ate & vglt 5. Separa tween adjacent fields 10' minimum 6. Pipes set on stable base T '- 7. Maximum 4' separation from edge of field to first line^ 8. Minimum two distribution lines Comments: "acnmg rus 1. Minimum inlet pipe 4" 2. Pits of concrete 3. Sidewall between 12" and 48" wide 4. Access manholes on each pit 5. Pipes cemented with hydr cement 6. Comments: K. Final Grade 1. Slope over soil absorption system minimum 0.02 2. All system components covered by at least 9" soil 3. Cover soil free of stones larger than 6" 4. Grading slopes away from dwelling 5. No areas over system that may pond 6. Grading meets 3:1 slope 7. Minimum of 9" of fill graded over system -1 0 c; z tA (:kr-i 2 ce W Cl. z 0 c td a c 0 0 mf 0 .Z O.Ij o c td a c 0 0 mf 0 .Z > 0 C: LA cz rz E LA .Ln 0 Q. LA 0 V) E rd v CLLL 11 Town of North Andover Office of the Health Department Community Development and Services Division 27 Charles Street North Andover, Massachusetts 01845 Sandra Starr Public Health Director TOWN OF NORTH ANDOVER BOARD OF HEALTH CERTIFICATE OF COMPLIANCE DATE OF COMPLIANCE 04/24W This is to certify that the distribution box and connection pipe constructed Q or repaired (X) by Jon Whyman at 2170 Turnpike Street Telephone (978) 688-9540 Fax(978)688-9542 has been installed in accordance with the provisions of Title V of the State Sanitary Code and with the North Andover Board of Health regulations. The Issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. ria LaGrasse Board of Health Inspector BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 :o-.. > 1t� i - �_ cam_ `ti.•. ? t�vC`�+.\�.. �` •mac ti . -Ui :�' C-sr.1�`' ;'r2%i �«: ,�._. J TOWN OE NORrrH ANDOVER SEWAGE,, DISPOSAI: SYST,Im I-NSTALLA-miN CERTIFICATION 'The uncersismed here'--v cerfv that the -ewa2e Disposal System i. ? Consu,ictrd; i,�u re^aired: b y u k N—1:1►�►'�l r� — -- located at i N1)AIUDo.I•e2 was installed in came-mance with the itto.th Andover Board of l t:Jth a-5proved plan, Svstert Design Pe::rit =dated Nit , an approved design [low of gallons per day The mate:ais;usec were in conrormarce :.--ith those specified oh the app'rov.a plan; the system was installed in accordarc t ,,,ith the provisions of 3110 CNIR l 5.000, Title 5 and local replations, and the final Qradirg agrees substantially with the approved plan. :til work- is accurateiv represented ;fir, the As-built Xhich has been submitted to the Board e� t-iealth. Bed inspection date : 18J pot tB, _. Engineer R orLse.-.:a ive Final inspect- care: __ .. .. ®� _ _ O -Cy ,j -- E-ngireA: Represe2mc, e Insta?'er: _-! `:c.T: Date: Cesi«n Eng-incer: z¢ Date:L--- TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System ( ) constructed; (� repaired; --I— I by \� v� C 0 A V . located at was installed in conformance with the North Andover Board of Health approved plan, System Design Permit # , dated , with an approved design flow of 7 gallons per day. The materials used were in conformance with those specified on the approved plan; the system was installed in accordance with the provisions of 310 CMR 15.000, Title 5 and local regulations, and the final grading agrees substantially with the approved plan. All work is accurately represented on the. As -built which has been submitted to the Board of Health. Bed inspection date: Engineer Representative Final inspection date: Installer Design Engineer Representative Lic.#: Date: Z ©Z - Date: AS -BUILT CHECKLIST LOT NUMBER, STREET NAME _ ASSESSORS MAP & PARCEL NUMBER J LOT LINES & LOCATION OF DWELLINGS i/ LOCATIONS & DIMENSIONS OF SYSTEM / INCLUDING RESERVE TIES TO LOT LINES & DWELLING WELLS a. FROM SEPTIC TANK b. FROM LEACH AREA LOCATIONS OF DEEP HOLES & PERC TESTS _ ELEVATIONS OF DISPOSAL SYSTEM .� TOP OF FDN ELEVATION LOCATIONS OF WELLS, DRAINS, WATERCOURSES WITHIN 150' OF SYSTEM LOCATION OF WATER, GAS, ELECTRIC LINES, CABLE DISTANCES FROM CORNERS OF HOUSE TO CENTER OF TANK & D -BOX ORIGINAL STAMP & SIGNATURE IMPERVIOUS AREAS - DRIVEWAYS, ETC. NORTH ARROW LOCATION & ELEVATIONS OF BENCHMARK USED 04/25/2002 17:14 9786851099 NE ENGINEERING SVC PAGE 02 NEW ENGLAND ENGINEERING SERVICES INC ,April 24, 2002 By Fax and Regular Mail North Andover board of health 27 Charles Street North Andover, MA. 01845 Re: 2170 Turnpike Street Dear Sandra: Please accept his letter as a clarification as to how the grading was corVleted at the above referenced property. The top of the slope is further away from the edge of the leach Meld titan was designed. This causes the actual slope to be steeper than designed but the Title 5 slopc requirement is still met because the toe of the slope is where it is supposed to be. The top of the slope is further from the leach field because the installer had more till than he needed to complete the job. If you have any questions regarding this matter please do not hesitate to call. Sincerely, Bena�n P6Q,_J,✓I T President 00 BEECHWOOD DRIVE -NORTH ANDOVER. MA 01845 - (978) 888-1768 -(888) 359-7645 -FAX (978) 685-1099 e W U 44 o � O z 0� V c DO C;3 . o �+ �+ P. o z o� o N C,3 � cV o wo 4 U T3 _� z o cria) 0 u a� �, cbo il 3 o N o 4-4 'o �+ o 0, 0 z W U Ey O � ° U u � CSSM cgCd b •� ° .� OU c'i w (uU � T3' c� o o��°, +, P, , x (,An -z0 x °o (�' A "" ¢ Ln o 0 O x N 0 0 N �i 44 O 9b 0 Gq ti Cd 2 t w r N n 0 Go co 0 0 U N J CG m N a W m O W z� z CA Lda Y F° z cri c� W U R" -V T. 04 O ]�C x .C�4} W ut KuLis i A QW O u ~• o �x LLO � U � N OAC O® .1.a C to L) O 4-1 . ►— iG �00 L -4 O L 4-1 w r N n 0 Go co 0 0 U N J CG m N a W m O W z� z CA Lda Y F° z cri c� W U R" -V Town of North Andover, Massachusetts Form No. 2 f MORT1y BOARD OF HEALTH O O � F w F DESIGN APPROVAL FOR SSACMUSEt SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant'.. ,.,/- 'ael /H6AII Test No. Site Location a�ZJ76 0/ Reference Plans and Specs WY Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. Fee CHAIRMAN, -BOARD OF HEALTH Site System Permit No. Town of North Andover Office of the Health Department (� F p J Community Development and Services Division UW 27 Charles Street Arap ��- -• North Andover, Massachusetts 01845 CHUS� Sandra Starr Telephone (978) 688-9540 Health Director Fax (978) 688-9542 October 5, 2001 Lori Balboni 2170 Turnpike Street North Andover, MA 01845 Dear Ms Balboni: This letter is to notify you that the septic system plans by New England Engineering Services, Inc., dated 09/27/2001 for the repair of the system at 2170 Turnpike Street, North Andover have been approved. Please note that the construction of this system requires an Order of Conditions from the North Andover Conservation Commission. Also, prior to the issuance of a Certificate of Compliance from the Health Department, a deed restriction must be filed limiting the number of bedrooms to three, and a copy submitted to the Health Department. This restriction is required because a variance has been granted to allow a separation of three feet to groundwater instead of four feet. If you have any questions, please do not hesitate to call me at the Board of Health Office at 978-688-9540. Sincerely, Sandra Starr, R.S., C.H.O. Health Director /CC: New England Engineering Services, Inc. Qom' File SS/aero 65004 00 oo,�Op--' BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 NURSE 688-9543 PLANNINIG 688-9535 rr .BOARD OF HEALTH . NORTH ANDOVER, MA 01845 978-688-9540 APPLICATION FOR SOIL TESTS _. BOARD OF HEALTH". FAR 198 2M1 DATE: g 8 fil MAP & PARCEL: / /) gC Ele-14-K R LOCATION OF SOIL TESTS: 21-70 -1'v,2 v►a�1u �i ; ati.. OWNER: 1--0 R t 3l!i-� AJ ► TEL. NO.: q78-- (. 8S- /a q ADDRESS: 21 `I o 1, i>, T. /v . 1q, -7 ENGINEER: A)Ew TEL. NO.: 97B- (69G-176,3 CERTIFIED SOIL EVALUATOR: R�c���n� C Tr�e'S 4^'a' Z"' G 17s4�a.QtJ rL Intended Use of Land: Residential Subdivision Is This: Single Family Home Commercial Repair Testing: 3o Undeveloped lot testing: -T- In the Lake Cochichewick Watershed? Yes No x THE FOLLOWING MUST BE INCLUDED WITH THIS FORM 1. Proof of land ownership (Tax bill, or letter from owner permitting test) 2. Plot plan & Location of Testing 3. Fee of $275.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of $75.00 per lot for repairs or upgrades. GENERAL INFORMATION 1. Only Certified Soil Evaluators may perform deep hole inspections. 2. Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system disposal area. 4. Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. 5. Full payment will be required for all additional tests within two weeks of testing. 6. Within 45 days of testing, a scaled plan (no smaller than 1"-100') shall be submitted to the Board of Health showing the location of all tests (including aborted tests). 7. Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Line N.A. Conservation Commission Approval: Date Received: Check Amount: Check Date: Vp C.\'E'N►G TINi= 9 i ! �!!man==!llw ilwlw!!! M?Mw�ww�ww..IMOL 'IMM wwwiw�wwwiMMMM�� f ■ciw�w!!®wwwwwwlwl�wlw!!!!= �l�i►�!lwwia�lwww!!lwwMw!!!!! Immarom m��iiwwwww�wiiww��wwwiww�www !®wwwlwlw!!w! MMMMMM ���;,w�w�w�www�lw�a��a�� �iwwiwwwi ww w� �!� �wli �wlllil�f lwlR�lwlwwlw�w ww,ALM Mwiwwwww���wiilw!! WE !w!w!w!!l7�ir!\�'lwww�ww�wlw�iii ��w�.�ww►�wl�w�► wl��w!!!ww wwl�lwwlwl1i!'!!li® �1�� 'lww�w� wwu-aw�ww���w�nr ww�w��..l�w� �'ww�wwiwsw 1 i r 1 o - � e t I No. 4 FORM 11 - SOIL EVALUATOR FORM Page 1 of 3 Date: Commonwealth of ].Massachusetts A/a. ,4v�� , Massachusetts Soil Suitability Assessment for On-site Sewage Disposat Performed$y:............................................................:.......................... Date: / .. ..� .. Witnessed By: ........... .......... ........r.-r...�................ .. .......................................................................... ............. . Laulan Aftcu « 09 7�/,�t/�/L��' owm-I NAM. Loz/ 45W446tv/! / Lot r / Tckplwrc Jew Construction ❑ Repair ❑ _Office Review Published Soil Survey Available: No ❑ Yes Q Year Published /9W/. ............... Publication Scale ����, .. Soil Map Unit Drainage Class d��r- 4- .............. Soil Limitations r ...... ................. I ....................... Surficial Geologic Report Available: No R1 Yes ❑ Year Published Publication Scale Geologic Material (Map Unit) Landform ...................... Flood Insurance Rate Map: Above 500 year flood boundary'No ❑Yes Within 500 year flood boundary No ❑Yes ❑ Within 100 year flood boundary No ❑Yes ❑ Wetland Area: National Wetland Inventory Map (map unit) Wetlands Conservancy Program Map (map unit) Current Water Resource Conditions (USGS): Month ��IL Range :Above Normal ❑Normal ZBelcw Normal ❑ Other References Reviewed: DEP APPROVED FORM • 12/07/95 1 I/ 5 FORM 11 - SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot i4o.EIZO 7 - On -site Review a Deep Hole Number ..::., Date:.. , :?� Time:.'?*.,, Weathe�/N-' S� Location (identify on site plan) ,L���S!.,...T...,......::..:.::............:::.:........:.......:::.....::...:....::. . Land Use :��/cYTG9L Slope Vegetation.. Landform i/.N..� ... .....:. ...........:....::::.::.......::......:::::...:.:..... Position on landscape (sketch on the back) ..:../ ..SOP Distances from: Open Water Body lfeet Drainage way /l¢�.. feet Possible Wet Area feet Property Line . 4ter..... feet Drinking Water Well feet Other DEEP OBSERVATION HOLE LOG` Depth from Surface (Inches) Soil Horizon Soil Texture (USDA) Soil Color (Munsell) Soil Mottling Other (Structure, Stones, Boulders, Consistency, % Gravel) /GT Z-1-/14 ca,4�s� �/'e L —s -MINIMUM OF 2 HOLES FILUU111W AI tvtnr rnvrvz)ty wo Parent Material (geologic) _5: y L �- Depth to Groundwater: Standing Water in the Hole: Estimated Seasonal High Ground Water: 4� DEP APPROVED FORM • 12/07/95 AMC/A Bedrock: - Weeping from Pit Face: "'-& ' 1%, 2:�ry fly 01-01-1Wm Location Address or Lot No. x176:' FORM 11 - SOIL EVALUATORFORN-1 Page 2 of 3 On-site Review Deep Hole Number ......... Date: Time;. Weather�;////_ Location (id t'f onsite plan) Land Use . . . . . . . ... O/Z? Slope M 2— Surface Stones ..... Vegetation Landform Position on landscape (sketch on the back) Distances from: Open Water Body/6#;$F`� feet Drainage way. feet Possible Wet Area feet Property Line . . .. ..... feet Drinking Water Well feet Other DEEP OBSERVATION -HOLE LOG* Depth from Surface (Inches) Soil Horizon Soil Texture (USDA) Soil Color (Munsell) Soil Mottling Other (Structure, Stones, Boulders, Consistency, % Gravel) 7 14 11/ Ze "�e - f MINIMUM OF Z HULbb tjtUWKtU A I tVtM T MUr"WOM' U10 Parent Material (geologic) C_ Depth to Groundwater; Standing Water In the Hole: Estimated Seasonal High Ground Water: DEP APPROVED FORM - 12107/95 P%nr^ Weeping from Pit Face: — rUKM It - JUIL I:VALL)A'I'UK IUXN1 Page 2 of 3 Location Address or Lot No. 01755-7 Z;E-_00910M 4V170492� 4n -site _Review p o Deep Hole Number ..7� Date:.. zzll Time;. /..'. � Weatherp/&_,�o Location (identify on site plant Tz .::::....4'T--.:..:.:...:.»:........::.::::.........:.......,.::,:......::...:......:..:.. . Land Use Slope M . Surface Stones :.. .r:...:....:. . Vegetation :...v�� jl':...:......,....:...:..:::..::...::...:.. ....... Landform ..:.�p21, /,�j>:.. _0 Position on landscape (sketch on the back) ..::�!...��:..:... Distances from: Open Water Body/6*74$va feet Drainage way. feet Possible Wet Area �f. feet Property Line . ...... feet SO Drinking Water Well ...:.. feet Other :.::.....:.........:.::.::::.:::. DEEP OBSERVATION HOLE LOG` Depth from Surface (Inches) Soil Horizon Soil Texture (USDA) Soil Color (Munsell) Soil Mottling Other (Structure, Stones, Boulders, Consistency, % Gravel) 4 �G A Z*'# Irz ' MINIMUM ur G nvLW n[uuincv Parent Material (geologic)�G Depth to Groundwater: Standing Water in the Hole: Estimated Seasonal High Ground Water: eZ_ DepthtoBedrock: Weeping from Pit Face: DEP APPROVED FORM • 12/07/95 /�y FORM 11 - SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot No.ox-9/2e-7 On-site Review Deep Hole Number ..::! Date: �z/�/ Time:Weather?/Xl- S4 . Location (identify on site plan)T��-:..!r Land Use ...:.. iD fll Slope M - Surface Stones :. . Vegetation.. :.::.....:... Landform Position on landscape (sketch on the back) Distances from: Open Water Bod/10101_1;�' feet Drainage way.1�L-�.. feet Possible Wet Area �G�.. feet Property Line . zr.. feet Drinking Water Well/lO feet Other :. DEEP OBSERVATION HOLE LOG` Depth from Surface (Inches) Soil Horizon Soil Texture (USDA) Soil Color (Munsell) Soil Mottling Other (Structure, Stones, Boulders, Consistency, % Gravel) -46 IrIlle- P� OF 2 HOLES RELIU114W AI tVt:HT rmuruoeu V10rVQML Parent Material (geologic) Cm�I�,�% / ` L G Dept Depth to Groundwater; Standing Water in the Hole: Estimated Seasonal High Ground Water: 2� DEP APPROVED F0101 • 12/07/95 Weeping from Pit Face; FORM 11 - SOIL EVALUATOR FOR -NI Page 3 of 3 Location Address or Lot Novi/�t-,--'L 1 Determination for Seasonal High Water Table Method Used: ❑ Depth observed standing in observation hole ................... inches ❑ Depth weeping from side of observation hole ..:............ inches ® Depth to soil mottles inches- ❑ Ground water adjustment .................. feet`Z Index Well Number .................. Reading Date .................. Index well level ................. Adjustment factor ................... Adjusted ground water level .............................................. Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in II areas observed throughout the area proposed for the soil ,absorption system? If not, what is the depth of naturally occurring pervious material? — Certification 1 certify that on.gk� (date) 1 have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR Z�C SignatureDate DEP APPROVED FORM • 12/07/95 `t NEW ENGLAND ENGINEERING SERVICES INC August 24, 2001 Sandra Starr, Administrator North Andover Health Department Town Hall Annex 27 Charles Street North Andover, MA 01845 Re: 2170 Turnpike Street, North Andover, Septic system design Dear Sandra: Enclosed are the following documents relative to the above referenced property. 1. 5 copies of septic system design plans. Two with original signatures. 2. Soil evaluator sheets. 3. Submittal form. 4. Check to cover the fee. If you have any questions please do not hesitate to contact this office. Sincerely, Benj&nin C. Osgo Jr., EIT President 60 BEECHWOOD DRIVE - NORTH ANDOVER, MA 01845 -.(978) 686-1768 - (888) 359-7645 - FAX (978) 685-1099 SEPTIC PLAN SUBMITTAL FORM LOCATION:.. 2170 !;,T"et AjpOlt 74,00,-o•edz NEW PLANS: YES $160.00/Plan REVISED PLANS: <0 $ 60.00/Plan L --- SITE EVALUATION FORMS INCLUDED: YES NO DATE: DESIGN ENGINEER:-. NCC,, Kn61,4,VP DATE TO CONSULTANT: When the submission is all in place, route to the Health Secretary. 't 2001 Town of North Andover, Massachusetts Form No. 1 NORTH BOARD OF HEALTH 16 0 Z. O41 R i * Cp `nue t`0 * _ AR COCM1CXEW14N APPLICATION FOR SITE TESTING/INSPECTION 7�QORATED SSACHUS� Applicant �1Z-� / � �—�'"T' -- . Site Location i, Engineer _ NAMES � /� A�D � S' J ?�J J7�U� TELEPHONE Test/Inspection Date and Time CHAIRMAN, BOARD OF HEALTH Fee Test No. h�r- S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. RESTRICTION The Restriction herein set forth shall apply and be appurtenant to the following described property located at , North Andover, Essex County, Massachusetts, being more particularly described as follows: A certain parcel of land located in North Andover, Essex County, Massachusetts, being shown as Lot on a plan entitled, "Plan of Land in North Andover, prepared for Said Lot containing square feet, more or less, according to said Plan. Being the same premises described in deed recorded with Essex North District Registry of Deeds in Book , Page 1. Maximum Number of Bedrooms At all times subsequent hereto, unless connected to an approved municipal sewer, the property described hereinabove shall be limited to use as a single family residence containing no more than three (3) bedrooms. This Restriction is being implemented due to the maximum capacity of the current septic system. 2. Enforceability These Restrictions may be enforced by the Town of North Andover, by action in equity in any Court of competent jurisdiction. Witness our hands and seal this Owners Owners COMMONWEALTH OF MASSACHUSETTS Essex, ss Date: The personally appeared the above named OWNER and acknowledged the foregoing to be their free act and deed, before me, Notary Public My Commission Expires: NEW ENGLAND ENGINEERING SERVICES INC October 1, 2001 Sandra Starr, Administrator North Andover Health Department Town Hall Annex 27 Charles Street North Andover, MA 01845 Re: 2170 turnpike Street, North Andover, Septic system design Dear Sandra: Enclosed are 5 sets of revised plans for the above referenced property. The following changes have been made. A 1. General note # 7 has been modified. , 2. The signature now indicates the discipline of the engineer. G 3. Ground elevations for test pit #I and #2 have been corrected. 4. A new percolation test has been performed and indicated on the plans. 5. The soil class has been changed to class III 6. The water line has been labeled as a pressure line. 7. Construction note #16 indicates that new tees are required in the existing septic tank. 8. A Special Design note has been added regarding the need for a deed restriction limiting the house to three bedrooms. Also enclosed is a plan approval request form and the sixty dollar re -submittal fee. If you have any questions regarding the information submitted, please do not hesitate to contact this office. Sincerely, —�------�_r., °if,-YI g OF RIOR - H ANDG-V Z 2/ BOARD CF" HE � H Benja (C Osgo ' r., EIT12001 President r? J 60 BEECHWOOD DRIVE - NORTH ANDOVER, MA 01845 - (978) 686-1768 - (888) 359-7645 - FAX (978) 685-1099 NEW ENGLAND ENGINEERING SERVICES INC HEAL-rH' 1,2001 August 25, 2001 North Andover Board of Health Town Hall Annex 27 Charles Street North Andover, MA 01845 RE: TITLE V REPORT: 2170 Turnpike Street, North Andover Dear Sirs:. Enclosed is a copy of the Title V report for the above referenced property. The system FAILED our inspection. If there are any questions please call me at my office, 686-1768. Sincerely Benjamin Osgood, Jr. 60 BEECHWOOD DRIVE - NORTH ANDOVER, MA 01845 - (978) 686-1768 - (888) 359-7645 - FAX (978) 685-1099 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION 1s1- NURTH AKDOi 7f 1/ "'DARE) QF igEAL"t h1 AIG C7 2001 TITLE 5 OFFICIAL INSPECTION FORM — NOT FOR VOLI:JNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM' PART A CERTIFICATION Property Address: ;<)7C, Iy e fi T1 f A,v ) pL t2 -t, ► k Owner's Name: Lo t2 1 6 A Gc,.,-j i Owner's Address: :;2,1 '7y T- ;Z N i 144- ST: 1V�'- P- -11-i /)A-;- Date )A; Date of Inspection: I Name of Inspector: (please print) e n )c` vy%,, � G (9- 0 Company Name: Aie,t- ttut-t� ��N G - Mailing Address: t c-) (liL Z G 1-l. wo 00) pjuC Telephone Number: 178- CERTIFICATION STATEMENT :.I certify that I have personally inspected the sewage disposal system at this address and that the information reported !below is true; accurate and complete as �of the time of the inspection. The inspection was performed based on my ,.training and experience in the proper. function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310. CMR 15.000). The system: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: - )z2 /4 r The system inspector shall submit a copy of this inspeeffon report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Page 2 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) 'ROPERTY ADDRESS: 2170 Turnpike Street. North Andover, MA DWNER Lori Balboni DATE OF INSPECTION: 5/22/01 Inspection Summary: Check A,B,C,D or E / ALWAYS complete all of Section D System Passes: ave not found any information which indicates that any of the failure criteria 15.303 or Iia,310 CMR 15.304 exist. Any failure criteria not evaluated are indicated be] Comments: B. System Conditionally in 310 CMR One or more system :compon is as described in the "Conditional Pass" section need to be replaced or repaired. The,system,. upon,completion\tht or pair; as approved by the Board of Health, will pass. Answer yes, no or not determined (Y,for the following statements. If "not determined" please explain. The septic. tank is metal -and ovee septic tank (whether metal or not) is ° structurally unsound, exhibits. substantial infiltration or e�tration or failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as appro by the Board of Health. *A metal septic tank will pass inspection7f it is structurally soun , of leaking and if a Certificate of Compliance indicating that the tank is less than 20,jears old is available. ND explain: Observation of sew a backup or break out or high static water level in a distribution box due to broken or obstructed pipe(s) or due o a broken, settled or uneven distribution box. System ' 1 pass inspection if (with approval of Board 7,1a'Ith): broken pipe(s) are replaced / obstruction is removed / distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if (with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed ND explain: Page 3 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A PROPERTY ADDRESS: 2170 Turnpike Street. CERTIFICATION (continued) North Andover, MA OWNER Lori Balboni DATE OF INSPECTION: 5/22/01 C. Further Evaluation is Required by the Board of Health: C ditions exist which require further evaluation by the Board of Health in order to determine if the system Fs failing to otect public health, safety or the environment. 1. System wi ass unless Board of Health determines in accordance with.310 CMR 15.303(1)(b) that the system is not t�nctioning in a manner which will protect public health; safety and the environment: Cesspool or prIV is within 50 feet of a surface water _ Cesspool or priv 's within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of H lth (and Public Water Supplier, if any) determines that the system is functioning:in a manner that prot the;public health, safety and environment: _ The system has a septic tank and soil abs, on system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surfs water pply. The system. has a septic tank and Z and the SAS ' within a Zone I of a public.water P / p ater supply. The system has a septic tank/and SAS and the SAS is w in 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less th 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance **This system passes if the well water analysis, performed at a DEP ce 'fied laboratory, for coliform bacteria and rlatile organic compounds indicates that the well is free fro ollution from that facility and the presence`of ammonia nitrogen and nitrate nitrogen is equal to or less than ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this fo 3. Other: Page 4 of I 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) PROPERTY ADDRESS: 2170 Turnpike Street. North Andover, MA OWNER Lori Balboni DATE OF INSPECTION: 5/22/01 D. System Failure Criteria applicable to all systems: You must indicate `yes" or "no" to each of the following for all inspections: Yes No _✓ _ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or 7 clogged SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool Liquid depth in cesspool is less than 6" below invert or available volume is less than %2 day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped ✓Any portion of the SAS, cesspool or privy is below high ground water elevation. . /Any portion of cesspool or privy is within 100 feet of a surface water supply or tributaryto a surface water supply. z Any portion of a cesspool or privy is within a Zone 1 of a public well. ✓ Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 1,00 feet but greater than. 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, a .a ::performed at a DEP certified laboratory, for coliform bacteria and. -volatile organic compounds :indicates that the well is free from pollution from that facility and the -presence of ammonia ...nitrogen and nitrate nitrogen is equal to or less than 5 ppm; provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.1 rj (Yes/No) The system fails. I have determined that one or more of the above.failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either `yes" or "no" to each of the following: (The followingtr�teria apply to large systems in addition to the criteriave) yes no _ _ the system is within 400 of a surface dr' ng water supply the system is within 200 feet of t u to a surface drinking water supply the system is loca n a nitrogen sensitive area im Wellhead Protection Area — IWPA) or a mapped Zone ll of a lic water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "Yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. Page 5 of I 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST PROPERTY ADDRESS: 2170 Turnpike Street. North Andover, MA OWNER Lori Balboni DATE OF INSPECTION: 5/22/01 Check if the following have been done. You must indicate "yes" or "no" as to each of the following: Yes No Pumping information was provided by the owner, occupant, or Board of Health Were any of the system components pumped out in the previous two weeks `? _ Has the system received normal flows in the previous two week period ? `Have large volumes of water been introduced to the system recently or as part of this inspection ? Were as built plans of the system obtained and examined? (If they were not available note as N/A) Was the facility or dwelling inspected for signs of sewage back up? ✓ _ Was the site inspected for signs of break out ? /Were all system components, excluding the SAS, located on site '? V1 Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum 'I, Was the facility owner (and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: Yes no Existing information. For example, a plan at the Board of Health. Determined in the field (if any of the failure criteria related to Part Cis at issue approximation of distance is unacceptable) [3 10 CMR 15.302(3)(b)) Page 6 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PROPERTY ADDRESS: 2170 Turnpike Street. North Andover, MA OWNER Lori Balboni DATE OF INSPECTION: 5/22/01 PART C SYSTEM INFORMATION FLOW CONDITIONS RESIDENTIAL, Number of bedrooms (design): Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): Number of current residents: 2 Does residence have a garbage grinder (yes or no): njo Is laundry on a separate sewage system (yes or no): Np [if yes separate inspection required] Laundry system inspected (yes or no): _ Seasonal use: (yes or no): No Water meter readings, if available (last 2 years usage (gpd)): i Sump pump (yes or no): AZo Last date of occupancy: c.,d COMMERCLUANDUSTRIAL Type of establishment: Design flow (based on 310 CMR 15.203): gpd Basis of design flow (seats/persons/sgft,etc.): Grease trap present (yes or no): Industrial waste holding tank present (yes or no): Non -sanitary waste discharged to the Title 5 system (yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER (describe): GENERAL INFORMATION Pumping Records Source of information: U fj 0, VX0 v\ Was system pumped as part of the inspection (yes or no): _ If yes, volume pumped: gallons -- How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM �6 Septic tank, distribution box, soil absorption system _ Single cesspool Overflow cesspool Privy _ Shared system (yes or no) (if yes, attach previous inspection records, if any) _ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) _ Tight tank _ Attach a copy of the DEP approval _ Other (describe): Approximate age of all components, date installed (if known) and source of information: Were sewage odors detected when arriving at the site (yes or no): 4`-5 Page 7 of I 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) ?ROPERTY ADDRESS: 2170 Turnpike Street. North Andover, MA OWNER Lori Balboni DATE OF INSPECTION: 5/22/01 BUILDING SEWER (locate on site plan) Depth below grade: i p ncT A�, p c L T Materials of construction: _cast iron _40 PVC _other (explain): Distance from private water supply well or suction line: Comments (on condition of joints, venting, evidence of leakage, etc.): SEPTIC TANK: _ (locate on site plan) Depth below grade: Z'< Material of construction: _concrete _metal _fiberglass _polyethylene _other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance (yes or no): _ (attach a copy of certificate) Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions determined: Comments (on pumpingrecommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): W c.TtIL t.eue — IN "TAn»ti O�e2 Ovi�r:. G GREASE TRAP:AIIA-(locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Page 8 of 1 I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) 3ROPERTY ADDRESS: 2170 Turnpike Street. North Andover, MA OWNER Lori Balboni DATE OF INSPECTION: 5/22/01 TIGHT or HOLDING TANK: -AA (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass _polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present (yes or no): Alarm level: Alarm in working order (yes or no): Date of last pumping: Comments (condition of alarm and float switches, etc.): DISTRIBUTION BOX: (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): 121 Q N a iL PUMP CHAMBER -.AA (locate on site plan) Pumps in working order (yes or no): Alarms in working order (yes or no): Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Page 9 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C O-VSTEM INFORMATION (continued) 'ROPERTY ADDRESS: 2170 Turnpike Street. North Andover, MA OWNER Lori Balboni DATE OF INSPECTION: 5/22/01 SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, excavation not required) If SAS not located explain why: Type leaching pits, number: _ leaching chambers, number: leaching galleries, number: leaching trenches, number, length: ✓leaching fields, number, dimensions: 5 i 2 C overflow cesspool, number: innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): �,l=t_o PatiD�� rvi car SZ>>�% CESSPOOLS: NQ. (cesspool must be pumped as part of inspection xlocate on site plan) Number and configuration: Depth — top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow (yes or no): Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): PRIVY: AA (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Page 10 of 1 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) 'ROPERTY ADDRESS: 2170 Turnpike Street. North Andover, MA OWNER Lori Balboni DATE OF INSPECTION: 5/22/01 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building.. r T) Page 1 1 of 1 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C 'ROPERTY ADDRESS: 2170 Turnpike Street. "STEM INFORMATION (continued) North Andover, MA OWNER Lori Balboni DATE OF INSPECTION: 5/22/01 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water feet V10 -i oe i 'u— VVV, n Please indicate (check) all methods used to determine the high ground water elevation: Obtained from system design plans on record - If checked, date of design plan reviewed: Observed site (abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health -explain: Checked with local excavators, installers- (attach documentation) Accessed USGS database -explain: You must describe how you established the high ground water elevation: ".a 14 5 4 €r a� l Ari 4 GBY; I I I I I h I 1 ! OC,=. �0 , "iii c_=l-OL=. i ION Ti M E _ t i Ii\rIE i TINi' - T A.:= i NOONAN & Mc DOWELL, INC. - 25 Bridge Street, Suite 6, Billerica, MA 01821-1023 Voice (978) 667-9736 Fax (978) 671-9565 Email: nm(a),netway.com Date: September 6, 2001 Town of North Andover Office of the Health Department Community Development and Services Division 27 Charles Street North Andover, MA 01845 RE: Subsurface Sewage Disposal System Plan Review, 1770/ 044 2170 Turnpike Street Assessors Map 108C, Parcel 8 Dear Members of the Board, Please be advised that Noonan & McDowell, Inc. has reviewed the plan dated August 23, 2001, by New England Engineering Services, Inc. It is our opinion that the proposed design will meet the requirements of Title 5 and the North Andover Board of Health `By -Laws" if the following is addressed: 1) Remove General Note 7. 2) Identify P.E. discipline MGL C112 s.81M 3) Check ground elevation for test pits 1 & 2, 220(4)(i). 4) The percolation test was not conducted at leaching area 102(2). This could be a condition of approval. 5) Given the perc rate, the soil is a Class III. 6) Identify water line as either pressure or suction 7) Provide note for upgrading outlet tee 227(4&6). 8) Deed restriction needed for 330 GPD design NA13.01. Respectfully, G� ohn L. Noonan, P.L.S.-P.E. Qoffice/forms/tonarev 1770044 Land Surveyors Civil Engineers Environmental Planners NOONAN & Mc DOWELL, INC. 25 Bridge Street, Suite 6, Billerica, MA 01821-1023 Voice (978) 667-9736 Fax (978) 671-9565 Email: nm@netway.com Date Z � --/ Town of North Andover Office of the Health Department Community Development and Services Division 27 Charles Street North Andover, MA 01845 RE: Subsurface Sewage Disposal System Plan Review, 1770/ 1-f4 Assessors Map /offG, Lot 7 Dear Members of the Board, Please be advised that Noonan & McDowell, Inc. has reviewed the plan dated Z '�; 7 - by -by It is our opinion that the proposed design will meet the requirements of Title 5 and the North Andover Board of Health `By -Laws" if the following is addressed: /) 6­� 49&� e:;---o-c— 77'25-- 7 M 0 e5�� 7 T--/ Y FF FJ 13' L 17 Z- 3- Tr T coir—s �v� 7-- 7 C C /°7' /fiAC�'"�� /J / S Co C"' Respectqully, 5' �. o John L. Noonan, P.L.S.-P.E. G: office/forms/tonarev 4,Z""". /f /1�o i JrC>/� t/ P��� p N �- Qv TL GAO Land Surveyors Civil Engineers Environmental Planners CHECKLIST FOR NORTH ANDOVER SEPTIC SYSTEM PLANS N & M Job 1770/ e `- r The following is a checklist that incorporates all Title 5 and local regulations for septic plans. Name of Applicant: L 02 1 Sf9G 1>0w l Name of Designer: S', Plan Date: �Z3 Revision Date: ' Date of Review: e Property Address: > y-v�'� �'� /' C- Jr 7- Ma PO Map: _ Lot: ti3 BOH Reviewer: Ll 4- Type of Plan (new or grade): Number of Bedrooms in Assessors -Records: gpd) Garbage Disposal Allowed: �— P e,-;-5 LG General Information: N.A. = North Andover Septic Regulations Other numbers refer to Title 5 OK Priem N/A N Street number and map/lot - 220(4)(u) --'" Maximum scale of 1 "=40' for plot plan - 220(4) Maximum scale of 1 "=20' for profile and component details - 220(4) Legal boundaries of the facility being served - 220(4)(a) Names of abutters from recent tax map - NA 8.02j ~------------ Number of bedrooms, design calcs., - NA 8.02i Name & address of record owner & applicant - NA 8.02k Name & address of designer - NA 8.021 Holder and location of all easements - 220(4)(b) Date plan drawn & any revision date - NA 8.02m L_ All dwellings and buildings, existing and proposed - 220(4)(c) Location of all existing' or proposed impervious areas - 220(4)(d) All distances on site plan - NA 8.03a -c ---^ Elevation of proposed driveway - NA 8.02t -' Location and elevation of foundation drain - NA 8.02y Location and dimensions of the system incl. reserve (new const.) - 220(4)(e) Limits of excavation of leach area on site plan - NA 8.02z i� Locus plan - 220(4)(t) (Not to scale) North arrow - 220(4)(g) v Existing and proposed contours - 220(4)(g) Locations and logs of deep holes - 220(4)(h) Locations and logs of percolation tests - 220(4)(i) Date(s) of soil testing - 220(4)(h) & (i) �---- - Existing grade elevation of each deep hole - 220(4)(h) Elevation of percolation tests - N.A. 8.02n ame of approving authonty representative - 220(4)(h) & (i) Name of soil evaluator - 220(4)0) �i Soil logs and perc test logs match BOH records _tG Locations of waterlines, drains, and subsurface utilities - 220(4)(m) Observed and adjusted g.w. elevation in the vicinity of the system - 220(4)(n) Complete profile of the system to scale - 220(4)(o), NA 8.02c r/ Cross section of leaching facility - NA 8.02w (Not to scale) Location of benchmark(s) within 50-75 feet of facility - 220(4)(q) Note listing all variance requests with proper citations - 220(4)(p) Local upgrade approval request form submitted - 403(1) �- Original R.S./P.E. stamp, signature & date - 220(1) & (2) zP"- If P.E., discipline specified within stamp. MGL C. 112 s. 81M sfc. supplies (w/in 400'), pub. wells (w/in 250'), pvt. wells (w/in 150') - 220(4)( Location of watercourses, wetlands, wells, etc. Win 150' of system - NA 8.02r Wetland disclaimer - NA 8.02s RLS plan reference & certification required (prop line setbacks) - 220(3) �- Use approvals / standards checked for UA system- DEP docs., y. 2 u Perc rate >30 MPI - not allowed for new, LUA for upgrade - 245(1)&('3) Perc rate > 60 MPI - must use modified tight tank or UA technology - 245(4) Proposed system qualifies as "shared" system - 002 (definitions) Flow is over 2,000 gpd - No R.S. allowed - 220(1) _ Design flow was set in accordance with code - 203 /e =>rN iC_ A, Existing system location and note on proper abandonment - 354 v Leaching facility at least 1' above Base Flood elevation — NA 9.05 All piping Sch 40 minimum — NA 10.01 -- Basement floor minimum 1' above groundwater elevation — NA 5.04 Foundation drain present with elevation — NA 8.02y On-site Soil and Groundwater Review OK Problem N/A Proper deep observation hole logs on plan - 220(4)(h) All deep holes and peres shown, including aborted tests — NA 8.02n Soil evaluation forms submitted within 60 days of'field work - 018(2) Proper percolation test log - 220(4)(i) G� Ample deep observation holes in primary disposal area (minimum 2) - 102(2) Ample deep observation holes in secondary disposal area (minimum 2) - 102(2) --- Ample perc testing (one in each disposal area, 3 in prim. > 2,000 gpd) - 104(4) E— Deep hole testing conducted within two years — NA 7.05 Hole Identification Numbers: ground elevation el. e_— acceptable -acceptable soil el. c„ Leach facilitv invert el. ground water el. refusal el. bottom of leach facility el. _ thickness of acceptable soil before & after soil R&R separation to groundwater separation to refusal soil class e perc rate loading rate septic tank below g.w. table (yes or no) pump tank below g.w. table (yes or no) l:f in fill -255(l) Setback Distances (Given in feet)15.21 1 YES NO Is the lot in the Lake Cochiewick Watershed? NA 6.00 & 5.02 OK Problem N/A Property line fCellar wall Septic Tank Leach Facility 10 10 10 20 2 Inground pool 10 Slab foundation 10 Deck, on footings, etc. 5 Waterline 10 Private drinking well 75 Irrigation well 75 Wetlands 75 Public well 400 �~ Wetlands bordering surface 150 water Supply or trib. (in Watershed) Trib. To Surface Water supply 325 Reservoirs 400 Tributaries to reservoirs 200 Drains (wat. supply/trib.) 50 Drains (intercept g.w.) 25 Foundation drains 10 Drains (Other) 5 Drywells 20 Downhill slope Building Sewer OK Problem N/A 20 10 10 10 100 100 100 400 150 325 400 200 100 50 20 10 25 15' to 3:1 slope w/o barrier Grease trap regw a for certain uses (check 230 for details) Pipe di r listed (4" minimum) - 222(1) Pi c edule listed - 222(3) Pipe cast iron or Sch 40 PVC — NA 11 A2 Watertight joints specified - 222(3) & (4) Pipe laid on compact, fin base - 221(5) , Pipe laid on continuous grade in straight line - 222 7 Cleanouts precede all changes in alignment ade - 222(8) Cleanout provided every 100 feet - 222 Manhole at any 90 degree alignme ange - 222(8) Invert elevation at building: Invert elevation at septic Length of run: Slope: (minimum of 0.01 - 0.02 desir -222(6) 10' o sett rivate well or suction line - 222( a 3 Septic Tank OK Problem N/A Tank is accessible - 228(3) No structures above tank - (228(3) Tank can accommodate both primary & reserve - NA 9.04 200% of flow (required & provided given. 1500 min.) - 220(4)(f) & 223)(1)(a) 2-3" drop from i t�outlet - 227(5) Minim 'liquid depth - 223(2) 3" space above tees/baffles-O inimum) - 227(4) "airspace abo a me (minimum) - 227(4) Tees are not to be replaced by baffles - 227(1) Tees extend 6" above flow line -227(l) Inlet tee extends 10" below flow line (minimum) - 227(6) - Outlet tee extends 14" below flow line (more for deeper tanks) - 227(6) Gas baffle installed on outlet - 227(4) Access manhole cover above center of tank & each tee (except 2 compart) 228(2) 3-20" manholes - 228(2) 3 childproof, 24" riser/manhole w/in 6" of final grade if <1000gpd- 228(2) Inlet and outlet tees on center line - 227(1) Soil compaction below tank specified (if soil is non-native) - 221(2) of <=3/41'stone beneath tank specified - 221(2) & 22 8(1) If > 1,000 gpd AND not a single fam. dwell. must be 2 tks or 2 comp. - 223(1)(b) If plan specifies disposal must be 2 tanks in series or 2 compart. tank - 223(1)(c) Buoyancy ca es. required if tank at or below water table - 221(8) V Tank ism' tertight - 221 (1) 9"o mover over tank (minimum) - 228(1) - 10 loading (min.) - H-20 if traffic - 226(3) Top of tank <=36" below grade - 221(7) All pumping to tank (if applies) in accordance with 229 Tank is set to keep old system in service during install if possible Distribution Box (Check here if not present: OK Problem N/A Inlet elevation: Outlet elevation: r5:-_ 0.17' drop from inlet to outlet (minimum) - 232(3)(b) _tom- 6". sump (minimum) - 232(3)(e) All outlets at same elevation - 232(3)(b) Outlet pipes laid level for first 2 ft. - 232(3)(c) �- Pipe Sch 40 - NA 10.01 ��-- Number of outlets: Number of laterals: Size of outlets: Inlet baffle/tee min. 1" over outlet invert for all d -boxes - 232(3)(a), Soil compaction below distribution box specified (if soil is non-native) - 221(2) 6" of stone beneath distribution box specified - 221(2) _ Box is watertight - 221 (1) -� Top of box <=36" below grade - 221(7) Buoyancy calculations required if box is at or below water table - 221(8) Pump Chamber (Check here if not present: ) OK Problem N/A Volume specified: 220(4)(r) Pump on elevation- 220(4)(r) Pump off elevation: 220(9(.r)' Alarm on elevation: 220(4)(r) Number of cycles per)(r) (also 254(1)(d) if gravity from d -box) Minimum 2" delivery line to d -box if gravity - 254(1)( c) 4 4 J Pressure dosed l.f. if flow >= 2,000 gpd - 254(1)(a) & 254(2)(a) . Cycles per day is consistent with chamber volume - 23.1 Volume calculations include flowback volume - 2') 1(2) 24 hour store -capacity above pump on elevation - 231(2) Number -of pumps: 2 if system serves >2 dwelling units - 231(6) pacity of pump(s) - gpm @ ' TDH - 220(4)(r) Pump can pass 1 1/4 "solids (minimum) - 231(7) Pump controls specified - 220(44)(r) Alarm equipment specified - 231 Alarm is in building and pow on separate circuit from pump - 2') 1(9) Pump sequence correct (o -lead on -lag on-alan-non) - 231(8 Pump performance c es included - 220(4)(r) Manual operating tch - NA 12.01 Check valve, b eder hole - NA 12.01 1 childproo 4" riser/manhole to final gra - 2'31(5), Soil col o action beneath pump chamb specified (if soil is non-native) - 221(2) 6"of —3/4"stone beneath chmbr. ified - 221(2) & 228(1), Bu ancy calculations if chain r is at or below water table - 221(8)@ 9" of cover over chamber n'mum) - 228(1) H- 10 loading (min.) - 0 if traffic - 226(')), Chamber is waterti '-221(l) Top of chamber <=36" below grade - 221(7) Leaching Facility (general - complete for all designs) OK Problem N/A .f 50% larger if garbage disposal - 240(4) Trenches to be used whenever possible - 240(6) No vehicle or imperv. area above1f. unless unavoidable - 240(7); NA 13.02 Vented if under impervious cover - 241 (1) Vented through same pipes as distribution system - 241 (1)(a) Vent protected from precipitation/animal entry - 241 (1)(b) Vent is placed beyond traffic or impervious area - 24 1 (1)(c) All lines connected to vent if bed or trenches - 241(1)(d) 9" cover over peastone - 240(9) Reserve area provided (new construction) - 248(1) Reserve 4' from primary leach area — NA 9.04 4'(5' if perc rate <=2 MPI) separation to g.w. - 212(a) & (b) 4' (down to 2' with variance or UA - upgrades only) of natural soil under l.f. GW separation is adjusted to highest existing grade if facility cuts into a hillside Pipe slope minimum of 0.005 - 251(9) . Require 5' removal and replacement if in fill - 255(5) Top of leach facility <= 36" below grade - 221(7) Final grade over l.f. minimum 0.02 ft/ft -240(10) Surface & subsurface drainage away from It - 240(1 1) & 245(5) Minimum design flow 440 gpd without deed restriction — NA 13.01 3:1 slope where grading required - 255(2) Toe of fill slope stops 5' from property line or swale installed - 255(2) Impermeable barrier if < 3:1 slope or < 15 feet to—3:Islope - 255(2) Impermeable barrier/retaining wall poured concrete — NA 9.02 Retaining wall stamped by P.E. - 255(2)(b) Top of retaining wall >= top of peastone elevation - 255(2)(f) 10' offset from edge of leach facility to edge of ret. wall - 255(2)(g) Perc test(s) done in most restrictive layer - 104(2) Perc test 4' below leaching elevation — NA 7.06 Design flow listed and required/provided leach area given - 220(4)(f) Leach pipes SCH40 PVC — NA 10.01 Leach pipes minimum 4" diameter except for dosed system — NA 14.04 Leach lines capped, vented, or connected together - 251(9) Pressure dosing guidance followed if pressure distribution - 254(2)(c ), Pressure dosing required over 2,000 gpd or with I/A remedial use - 231(1) 5 ,v 6 Leaching Trenches (Check here if not present: ) OK Problem N/A Number of trenches: Minimum of 2 trenches - NA 9.01(2) Depth of trenches (max eff. 2'): -247(l) Width of trenches (2' min., l max.): - 251 (1)(b) Length of trenches. (100' max.): - 25 1 (1)(a) Trenches are vented (when > 5/deh '1) Trenches follow cont lines - Trench spacing. -s effectivdepth minim - 251 (1)(d) In fill or reserve tween trenchn. - NA 14. & 14.03 Available leac ea given (Mn.- NA 9.0 2) Bottom L x x = s.f. Side 1=L xDx# x2= s.f. Effective each ea given d.factor: E ective area = total area.f. x LTAR = g/day Effective area is >= design flow being served 2"of 1/8"- 1/2" 2x washed peastone.- 247(2) Trench depth of 3/4" to 1 1/2" double washed stone - 247(1) Leach Fields (Check here if not present: ) OK Problem N/A Number of fields: (need dosing chamber, if > 1, 231 (1)) Length (100' max.): - 252 (2)(b) E— Width: Total area: L x W - = s. f c� Minimum 900 square feet - NA 9.01(1) % Distribution lines connected with solid pipe — NA 15.01 6Z isv 0 u D Effective leach area given Loading factor: Effective area = total area s.f x LTAR— g/dav Effective area is >= design flow of facility being served Minimum of two distribution lines - 252(2)(a) �--> 6' line separation (max.) - 252(2)(d) 4' maximum separation from edge of field to line - 252(2)(e) ^-' 10' minimum separation between adjacent leach fields - 252(2)(f) Between 6" and 12" of 3/4 - 1 1/2" stone beneath field - 252(2)(g) & 247(2) 2"of 1/8"-1/2" 2x washed peastone.- 247(2) Final Grading OK Problem N/A 1C Slope over leach area minimum of 0.02 feet/foot — 240(10) Grading shall divert drainage away from leach area — 240(l 1) —� Grading slopes away from dwelling 5/24/01 f:/office/forms/tonackltr.doc 6. Project Request Record Town of North Andover Date: r13 'glo Client Id: ToNA Card Id: ToNA Client/Company Name: Board of Health �7Card"hype=Chani G +ontact1Name Ms: Sandra Staff.,.:r Phone 978 688-9540 , t tJ. ��lTitle. D>rector+ Fax,, 97;8 688=95421 .•j' ; !!/r, „f i;rl f( /Address 27`Charles;Street Email sstarr@townofnorthandoverco`m,' r`j!"'. Notes ., �iTrown Andover Ij„Ftlr { �!/State.' ! MAt Zip Code ! 01845 ,, rs ;,,, if rr, �>,�r rr ' J l Uther, contacts, pg ? ,!' �,t' tf a hcable i E Installer, , , t �fttlr d, u , IlName "�vv 6 Ghone: _ _ 7 IIrx #iAe, Fax.. pr, p lidtf i ;1 77-777 / e ,'+Address Emaih. 1Votes •; own rl�rt tf f /t State: flip Code ° 1' i £�"! Proiect• Project Id: 1770 Project Title: Town of North Andover. Board of Health (JOB NO) (PROJECT NAME & STREET ADDRESS) Manager: NOW Billing Group: Billing Cod Fixed Fee ;,Contract Info Project Descnphonfor each billing+,group' Applicant, sessors:lVlap+ n S C ':I;ot 3r—,. Street, r% 7 4 tipdT YPeof service - r „d Offic.dforms/jbrqutona I r No. /,--�-,/ FORM 11 - SOIL EVALUATOR FORM Page 1 of 3 Date:. 222, 11/ Commonwealth of Massachusetts ,44v,!�w'4!5� , Massachusetts Soil Suitability Assessment for On-site Sewage Disposal Performed By: ........ ....Jcl...illl� Date: Witnessed BY: ....................= 1-�� /............................................... __ Lzut , Addressor o? 17a/L-,4-- o � a Lois! Lot r y �O Aftus. and . /Y ��;/7%m[�� —Z / / 7� Tckphonc / ew construction ❑ Repair ❑ ulnce iKevlew Published Soil Survey Available: No ❑ Yes Q Year Published /?-6p/ ................ Publication Scale ����, Soil Map Unit Drainage Class f Wil- 4- ............. Soil Limitations :7r�0�......�����................................. Surficial Geologic Report Available: No R1 Yes ❑ Year Published Publication Scale Geologic Material (Map Unit) Landform ...................... - -._........................................................................................_-._........... Flood Insurance Rate Map: Above 500 year flood boundary No ❑ Yes KI Within 500 year flood boundary No ❑Yes ❑ Within 100 year flood boundary No ❑Yes ❑ Wetland Area: National Wetland Inventory Map (map unit) Wetlands Conservancy Program Map (map unit) Current Water Resource Conditions (USGS): Month 14PIZIL Range :Above Normal ❑Normal TIBelcw Normal ❑ Other References Reviewed: DEP APPROVED FOPM . 1210719S FORM 11 - SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot No. /1/11.1/P/k'�E On-site Review Deep Hole Number ..::., ..,. Date:.. /�� Time:. Weathe WAI— Location (Identify on site plan)-%��N.T ...._.,.,�" . .....:.......: Land Use 1��2)A.eY7 —' Slope (%) 3.. Surface Stones .. . Vegetation.. Landform ..:::. ��32Giy%� ../f�OlL�j/� ... .....:. ..........::....::...........,:......:.::. ,:..,..... Position on landscape (sketch on the back) ..,../:...�o�z Distances from: Open Water Body ���� feet Drainage way/c feet Possible Wet Area ��� feet Property Line . '¢ter....... feet Drinking Water Well feet Other ...... .... . .........,..,...,., DEEP OBSERVATION HOLE LOG` Depth from Surface (Inches) Soil Horizon Soil Texture (USDA) Soil Color (Munsell) Soil Mottling Other (Structure, Stones, Boulders, Consistency, % Gravel) ::;'-AG 7— S :171-A Parent Material (geologic) �%17%_,�G% %% /- C— Depth to Groundwater: Standing Water in the Hole: Estimated Seasonal High Ground Water: 4V ✓ DEP APPROVED FORM • 12/07/95 Weeping from Pit Face: — FORM 11 - SOIL EVALUATOR FOIZN-j Page 2 of 3 Location Address or Lot No. :Z;?/ On-site .Review Deep Hole Number ...... Date: -r/. �p� Time:. ��.I Weather/P/.y— �Od Location (idenntlify on site plan), .?it;: Soil Texture (USDA) Land Use ........ l7 {���r�� Slope (%) v, Surface Stones :.. .,...:.....: . Vegetation :../(mc%-........... :. . ...:............. Landform ..::i��l/�If.% ::... Position on landscape (sketch on the back) ..'�:....1-mP, ..,....... Distances from: Open Water Body/`� feet Drainage way. !a feet Possible Wet Area /Zo feet Property Line . feet Drinking Water Well feet Other.. :.............,.:... ,..,:.: DEEP OBSERVATION'HOLE LOG* Depth from Surface (Inches) Soil Horizon Soil Texture (USDA) Soil Color (Munsell) Soil Mottling Other (Structure, Stones, Boulders, Consistency, % Gravel) � - 97 APO/ ,� 1 MINIMUM UF 2 HOLES REQUIRED AT EVERY PRO =POSAY ARFA Parent Material (geologic) Depth to Groundwater: Standing Water in the Hole: Estimated Seasonal High Ground Water:_� DEP APPROVED FORK[ - 12/07/95 Weeping from Pit Face: — i CUKM 11 - JU1L 1:VALUAIUK 1qU1t111 Page 2 of 3 Location Address or Lot No. 4n -site .Review Q o Deep Hole Number .. ..,: Date:.. zzl� Time:./ Weather/— TZ¢sr<l C'�, S ,� Location (identify on site plan) .,.... v.,:......,.,......,... .. ....::.......: Land Use Slope Surface Stones ,.. ., ...v.:.:....: Vegetation Landform ..:.�;9_ 61V Position on landscape (sketch on the back) .. ,:�%:....��...,....... Distances from: Open Water Body��o feet Drainage way. /�� v . feet Possible Wet Area �� ... feet Property Line . �-.... feet SO Drinking Water Well .�..:.. feet Other :.:,....::..,...........,.,..::,__,:.: DEEP OBSERVATION HOLE LOG` Depth from Surface (Inches) Soil Horizon Soil Texture (USDA) Soil Color (Munsell) Soil Mottling Other (Structure, Stones, Boulders, Consistency, % Gravel) 55 /eT J�%vcT Parent Material (geologic) Depth to Groundwater: Standing Water in the Hole: i Estimated Seasonal High Ground Water: 47 DEP APPROVED FORM - 11/07/95 DepthtoBedrock: Weeping from Pit Face: FORM 11 - SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot No.o�/2a On-site Review Deep Hole Number ..::! Date: -Z/�� Time:. -:cam Weathers/X� s0 D Location (identify on site plan)��— Land Use...... L Slope (%) - Surface Stones Vegetation : ...... n..v. ,,.... , . Landform Position on landscape (sketch on the back) Distances from: Open Water Bod/-'""�p feet Drainage way.��'�.. feet Possible Wet Area �G�.. feetProperty Line .27 feet Drinking Water Well/lfeet Other DEEP OBSERVATION HOLE LOG` Depth from Surface (Inches) Soil Horizon Soil Texture (USDA) Soil Color (Munsell) Soil Mottling Other (Structure, Stones, Boulders, Consistency, % Gravel) y � �j67— ` MINIMUM OF Z HULLL5 HtUUIHtU AI tvttmy rnurwru uiarvanu Parent Material (geologic) C �%yl� / ` LG Del: Depth to Groundwater; Standing Water in the Hole: Estimated Seasonal High Ground Water: DEP APPROVED FORhI - 12/07/95 CH Weeping from Pit Face: DORM 11 - SOIL LVALUATOR FORM Page 3 of 3 Location Address or Lot Nook/�O Determination for -Season I High Water Table Method Used: ❑ Depth observed standing in observation hole ................... inches ❑ Depth weeping from side of observation hole ............... inches ® Depth to soil mottles inches J3 ❑ Ground water adjustment .................. feet , z --sem - -- Index Well Number .................. Reading Date .................. Index well level .............. Adjustment factor ................... Adjusted ground water level ........................................ . Depth of Naturally Occurring Pervious --Material Does at least four feet of naturally occurring pervious material exist in I! areas observed throughout the area proposed for the soil absorption system? If not, what is the depth of naturally occurring pervious material? — Certification I certify that on Q� (date) 1 have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR 15 Signature ` Date AEP APPROVED FORM • 12/07/95 V -SO40p, . ]k MMMIMMMM' mi.M--:mu ®mws�� mm= � UUT ME �MiY�l►1i Blom=�� MMM I''Ili Ilft� `✓==-OLi ICON i i ._ c I Ofvl Dc. I I[VI � L.'-iC^^ .. T i ivI s _T; I 12I .. T ilvIE ,—. I SEPTIC PLAN SUBMITTAL FORM LOCATION: v2 I Z Q "jy ` G /�/ , �� 7 NEW PLANS: YES $160.00/Plan REVISED PLANS: YES $ 60.00/Plan .- tc SITE EVALUATION FORMS INCLUDED: YES NO DATE: , DESIGN ENGINEER: DATE TO CONSULTANT: o�/ %tj ���C�� m` When the submission is all in place, route to the Health Secretary. BOARD OF HEALTH NORTH ANDOVER, MA 01845 978-688-9540 APPLICATION FOR SOIL TESTS DATE: > I MAP & PARCEL: LOCATION OF SOIL TESTS: '?)-7C T�2V►o, S i ; �� �.. u�,� P OWNER: ,� tZ i w��►� tia TEL. NO.: cj78-- b p,'5- — 10 `f ADDRESS: t 'z v apt5T.. fv . A "r? ENGINEER: ) ,�,✓ l e 1=v�i;,Re ��,2� . TEL. NO.: 'J CERTIFIED SOIL EVALUATOR: R�c��uab�'- C T w� enC Intended Use of Land: Residential Subdivision Single Family Home Commercial Is This: Repair Testing: x Undeveloped lot testing: In the Lake Cochichewick Watershed? Yes No �C THE FOLLOWING MUST BE INCLUDED WITH THIS FORM 1. Proof of land ownership (Tax bill, or letter from owner permitting test) 2. Plot plan & Location of Testing 3. Fee of $275.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of $75.00 per lot for repairs or upgrades. GENERAL INFORMATION 1. Only Certified Soil Evaluators may perform deep hole inspections. 2. Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system disposal area. 4. Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. 5. Full payment will be required for all additional tests within two weeks of testing. 6. Within 45 days of testing, a scaled plan (no smaller than 1"-100') shall be submitted to the Board of Health showing the location of all tests (including aborted tests). 7. Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Line TOWN OF NORTH ANDC' BOARD OF KAM- N.A. Conservation Commission Approval: Date Received: Check Amount: Check Date: APR 2801 V Y fAfL,l.2k' v9; .f t'rr k�+p 31r APR 1 8 2001 DATE: > I MAP & PARCEL: LOCATION OF SOIL TESTS: '?)-7C T�2V►o, S i ; �� �.. u�,� P OWNER: ,� tZ i w��►� tia TEL. NO.: cj78-- b p,'5- — 10 `f ADDRESS: t 'z v apt5T.. fv . A "r? ENGINEER: ) ,�,✓ l e 1=v�i;,Re ��,2� . TEL. NO.: 'J CERTIFIED SOIL EVALUATOR: R�c��uab�'- C T w� enC Intended Use of Land: Residential Subdivision Single Family Home Commercial Is This: Repair Testing: x Undeveloped lot testing: In the Lake Cochichewick Watershed? Yes No �C THE FOLLOWING MUST BE INCLUDED WITH THIS FORM 1. Proof of land ownership (Tax bill, or letter from owner permitting test) 2. Plot plan & Location of Testing 3. Fee of $275.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of $75.00 per lot for repairs or upgrades. GENERAL INFORMATION 1. Only Certified Soil Evaluators may perform deep hole inspections. 2. Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system disposal area. 4. Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. 5. Full payment will be required for all additional tests within two weeks of testing. 6. Within 45 days of testing, a scaled plan (no smaller than 1"-100') shall be submitted to the Board of Health showing the location of all tests (including aborted tests). 7. Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Line TOWN OF NORTH ANDC' BOARD OF KAM- N.A. Conservation Commission Approval: Date Received: Check Amount: Check Date: APR 2801 10 -on 5 Ei 5 � A 11 mme 6� BOARD OF HEALTH NORTH ANDOVER, MA 01845 978-688-9540 APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: Z CURRENT INSTALLER'S LICENSE# 00 LOCATI N:y �� LICENSED INST LER: a WcL SIGNATURE: ONE# 133 q 73 .Z CHECK ONE: REPAIR: �.. NEW CONSTRUCTION: IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS -BUILT. 160.00 Fee Attached? Project Manager Ob. Foundation As -Built? Floor Plans? Administrative Use Only Yeses_ No Yes --�—''� No Yes No Yes. No Approval Date: INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction of the septic system for the property at L v J_"t elative to the application of ` &dated Z 2- for plans by d s Jand dated with revisions dated I understand the following obligations for management of this project: 1. As the installer I am obligated to obtain all permits and Board of Health approved plans prior to performing any work on a site. I must have the approved plans and the permit on site when any work is being done. 2. As the installer I must call for any and all inspections. If homeowner, contractor, project manger, or any other person not associated with my company schedules an inspection and the system is not ready then item three shall be applicable. 3. As the installer I am required to have the necessary work completed prior to the applicable inspections as indicated below. I understand that requesting an inspection, without completion of the items in accordance with Tile 5 and the Board of Health Regulations may result in a $50.00 fine being levied against my company. a) Bottom of Bed - generally first inspection unless there is a retaining wall which should be done first. Installer must request the inspection but does not have to be present. b) Final inspection — Engineer must first do their inspection for elevations, ties, etc. As -built or verbal OK from engineer must be submitted to Board of Health, after which installer calls for inspection time. Installer must be present for this inspection. With pump system all electrical work must be ready and able to cause pump to work and alarm to function. c) Final Grade = Installer must request inspection when all grading is complete. Does not have to be on site. 4. As the installer I understand that only I may perform the work (other than simple excavation) required to complete the installation of the system identified in the attached application for installation. I further understand that work by others unlicensed to install septic systems in North Andover can constitute reasons for denial of the system, and/or revocation or suspension of my license to operate in the Town of North Andover; significant fines to all persons involved are also possible. 5. As the Installer I understand that I must be on site during the performance of the following construction steps: a) Determination that the proper elevation of the excavation has been reached. b) Inspection of the sand and stone to be used. c) Final inspection by Board of Health staff or consultant. d) Installation of tank, D -box, pipes, stone, vent, pump chamber, retaining wall and other components. 6. As the installer I understand that I am solely responsible for the installation of the system as per the approved plans. No instructions by the homeowner, general contractor, or any other Persons shall absolve me of this obligation. Licensed Septic orks # Imo% Date: f� C .. . is CELL FAII _�' •, / " 1 , / / 91 �, •� �.� it �,7 -.4 11711 ONE WR11 � i -��>- TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: `�— 9 SYSTEM OWNER & ADDRESS a 1-70—C-ucv'\ �ki-e s -+- SYSTEM LOCATION (example: left front of house) DATE OF PUMPING: QUANTITY PUMPED GALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES / NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION HEAVY GREASE ROOTS EXCESSIVE SOLIDS SOLIDS CARRYOVER FULL TO COVER BAFFLES IN PLACE LEACHFIELD RUNBACK FLOODED OTHER (EXPLAIN) SYSTEM PUMPED BY: COMMENTS: CONTENTS TRANSFERRED TO: �� _. �- ✓�/ ,IAN . 5- � - Commonwealth of Massachusetts ,(Massachusetts System Pumping Record System Owner L --QS t` e Date of Pumping: t - — it— qq Cesspool: No W___ Yes [I System Pumped by: V4&,& ct System Location Quantity Pumped: lVz)� gallons Septic Tank: No [ ] License # Contents transferred to: Greater Lawrence Sanitary District Date: Inspector: Yes Ft' JAN 2Q;_� Ir .2r k 474 41 r - t �' �� � ."{ .r - .y' _ .fiery .�, I� j.•. • t - s. ... ? �}: -,�.v _ � :,;'.+ r� L � ...:: �, {.. f.s s ��V • �` � . Vy' �. t` _ � S ,�, 1 � f' �.. Y-..uuyyflli _ ' e. ; - f a r n } • t � i' .t,t C �����'~ � , f aw ?z.,'. 1f �� - 1 4 I, - 4 M1 a - ,�� - .A1 r 'i*.�Y{y �J -��� fir. .� r^-••� +r--3- — _— - ( ,\. r� f! tit (t �Gti `�Q �, ► � � � f,' � 4 � � i � � -, it IN 36 �. t Y ' :�} c NJ ir 44 .�- 4 _ 19 Lo NI 4 VL 21 Nk VIT LI t ffll�j` � �'�,� �. ► i e �, r 1 ,i � t� � �• i. i 'r I � .� ;��. r ,,� ��...:� � r """' et W �. � .i � i N . � - Y 1 ,i � t� � �• i. i 'r I � .� ;��. r ,,� ��...:� � r """' a.� � tiv d�u r oA AL� � J SOIL PROFILE & PERCOLATION TEST DATA Town/City No.&StreetZ ,// Lot No. j Loc./Subdiv. Plan Owner Investigator ,�__',',_ A(:g_g //� Observer, SOIL PROFILES -DATE 1' E . 26 Elev. 3. 4 ev. 0 20 ev7 7 Elev., . ---Elev. 0 0 0 2 1 3 1 4 5 6 3 7 9 1 2' 3 4 5 6 7 - 8 9 2 4 5 6 7 8 9 10 !�— 10 10 ---� 10 Benchmark Location Elevation Datum Percolation Tests -Date 7T72.,77-7 Pit Number 1 2 3 4 5 Start Saturation .3 Soak -Mins. Start Test -Time S / Drop of 3" -Time Drop of 6" -Time v Mins.lst 3"Dro 2 Mins . 2nd 3"Dro 3"S'1 .. ivores & Sxetcnes on Back Frank C. Gelinas & Associates, North And. G 6,o2 ,1 1S % ell A 1 2 16e� /,f 11-f- lcle7lle ell t .a...'s^ .: .. - .•ri+r .+...p, w+.qv"e.•a.rtYM+.kww*vtyr.I+wmwee�..�+v...{.,�1s.��w4or a.�.w�{�: w�.ww. r ..., vvmvara�n✓�^rEcv w5:�� s —../��..Ey�.�J/x a•I!w�+F 9R^_r t�a-k {���s' 4��{^:�'oi/�.l �'S Pg�' � .% � ,,�� /�fRr /' xs,t 6 �+ a .. p .. t IM/+•.T I ... A � dry � t( Y4 Fey S ti 1 Y ��7 .. .�...+�....,�.....�.�•�°`* +".^!'.s'c'an TO: FROM: NORTH ANDOVER, MASS /SFS 2 Z 19 -79 BOARD OF HEALTH DESIGN ENGINEER Re: Soil Absorption Sewage System I nspection This is to certify that I have inspected the construction of the said disposal system at �6 % 1�4 R1y)°1/_1a: North Andover, Mass. SITE LOCATION The grades and construction are as specified in my plans and specifications dated 19 �4�a eOMn� eg. P of in&- Rer. a`nilarian r TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: Lo - SYSTEM OWNER & ADDRESS I SYSTEM LOCATION (example: left front of house) \A� Z�-71Y- �a6a2___, DATE OF PUMPING: QUANTITY PUMPED,&GALLONS CESSPOOL: NO 1z YES _______ SEPTIC TANK: NO � YES NATURE OF SERVICE: ROUTINE ( / = EMERGENCY OBSERVATIONS: GOOD CONDITION HEAVY GREASE ROOTS ---- EXCESSIVE SOLIDS �— SOLIDS CARRYOVER SYSTEM PUMPED BY: ,OMMENTS: ONTENTS TRANSFERRED TO: FULL TO COVER BAFFLES IN PLACE LEACHFIELD RUNBACK FLOODED -- OTHER (EXPLAIN) TCS � BOAOU H A© T 2002 IT ADO�� V 6 r / f �S ail 4-26-02; 9: Q7ANI; US DOL/PWBA. Boston BY FACSIMILE 978-688-9542q /0 S April 25, 2002 Ms. Sandy Starr, Director Board of Health Town of North Andover Re: Septic System New Installation 2170 Turnpike St. North Andover Dear Ms. Starr: ;6175659667 # 1/ 4 Please accept the following information regarding the installation of a new septic system at the above referenced property. I am an attorney licensed to,practice in the Commonwealth of Massachusetts and will be representing myself and my co-owner/mother Jeanne M. Leslie in the sale of the property located at 2170 Turnpike St. I have attached the "Quitclaim Deed" and "Notice of Variance/Deed Restriction" that will be recorded at the Essex North Registry of Deeds upon sale of the property. I have provided both the Deed and Variance/Deed Restriction to the buyers' attorney, Russell Bodnar, 565 Turnpike St., North Andover, MA. Attorney Bodnar has reviewed the Deed and Variance/Deed Restriction and is in agreement with the documents. Any assistance you can provide in expediting approval and issuance of the Certificate of Compliance for the new septic system would be greatly appreciated. If there is any other information you require to complete the approval process please call me at (617) 565-1393. Thank you for your assistance. Very truly yours, d Lori J. Moccaldi (Balboni) 4-25-42; 9:07AM;US GOLiPh''B.A Boston ;6175659667 QUITCLAIM DEED We, Jeanne M. Leslie and Lori J. Nloccaidi (formerly known as Lori J. Balboni) of North Andover, Essex County, Massachusetts grant to Jayesh B. Patel and Damini N. Patel as Tenants by the Entirety of Beverly, Essex County, Massachusetts for consideration of Two Hundred and Seventy -Two Thousand Five Hundred and no/100 ($272,500.00) dollars .with QUITCLAIM COVENANTS the land, together with the buildings thereon, situated in North Andover in said Essex County and bounded and described as follows: Beginning at a drill hole in the wall at land now or formerly of C.S. Berry and on the northeasterly side of Turnpike Street; thence running easterly ,along said Turnpike Street two hundred thirty and 41/100 (230.41) feet to an iron post set in the ground thence running northeasterly by Lot 2 on a plan of land in North Andover as surveyed for Matthew F. Dowd, 1946, Ralph B. Brasseur, Surveyor,. a distance of three hundred fourteen (314) feet to an iron post; thence running westerly by land now or formerly of Putnam Town three hundred fifty-four (354) feet as a wall stands to an iron post at the corner in the wall at land now or formerly of C.S_ Berry, thence running a little more westerly by the wall and said land now ,or formerly of C.S. Berry forty-four (44) feet to the point of beginning. Said premises are shown as Lot I on plan hereinbefore mentioned. For my title see decd of Jeanne M. Leslie and Lori J. Balboni dated October 30, 1992, and recorded with Essex County Registry of Deeds, Book 3636, Page 339. Witness my hand and seal this day of , 2002. Witness: Jeanne M. Leslie Witness my hand and seal this day of , 2002. Witness: Lori J. Moccaldi # 2/ 4 4-25-02; 9; 07,AM; US DDL,/PWBA. Boston ;6175659667 # 4/ 4 NOTICE OF VARIANCE/DEED RESTRICTION Pursuant to 310 CMR 15.000 Title 5, and as a condition of the North Andover Board of Health Disposal Works Construction Permit # 1169, dated April 1, 2002, notice is hereby given that real estate located at 2170 Turnpike Street, North Andover, Massachusetts, as described in a deed from Jeanne M. Leslie and Lori J. Moccaldi (formerly know as Lori J. Balboni) to Jayesh B. Patel and Damini N. Patel, dated 2002 and recorded in the Essex County Registry of Deeds in Book and Page , and as Document # , is the subject of a variance from the Town of North Andover Minimum Requirements for the Subsurface Disposal of Sanitary Sewage A1.05 and C9.01(4). Said variance limits the maximum number of bedrooms at this dwelling to three bedrooms. This variance is within the jurisdiction of the North Andover Board of Health. Signed and sealed this day of , 2002. Jeanne M. Leslie Lori J. Moccaldi COMMONWEALTH OF MASSACHUSETTS 'ss. Date: Then personally appeared the above-named Jeanne M. Leslie and Lori J. Moccaldi and acknowledged the foregoing instrument to be their free act and deed, before me. Notary Public My Commission Expires: 4-25-02; 9:07,A1vI; US DOL/P'WB.A Boston ;6175659667 # 3t 4 COMMONWEALTH OF MASSACHUSETTS 2002 i`hen personally appeared the above-named Jeanne M. Leslie and acknowledged the foregoing instrument to be her free act and decd. Before me, ,ss. Notary Public My Commission Expires: COMMONWEALTH OF MASSACHUSETTS 2002 Then personally appeared the above-named Lori I Moccaldi and acknowledged the foregoing instrument to be her free act and deed. . Before me, Notary Public My Commission Expires: Commonwealth of Massachusetts NORTH ANDOVER . Massachusetts RECEIVED NOVQ 0 2007 &stem ftmpine Record TOWN OF NORTH ANDOVER HEALTH DEPARTMENT System x%ner bystem Location MIKE CHASE 2170 TURNPIKE ROAD Date of Pumping: 11/15/07 Quantity Pumped: _1000 gallons Cesspool: No © Yes , ❑ Septic Tank: No ❑ Yes ❑ RAGGS SEPTIC SERVICE, INC. _ System Pumped by: d.b.a. E . A. COMEAU SEPTIC License r: Contents transferred to: WATER SOLUTIONS GROUP, TAUNTON: Date 12/15/07 Inspector RAGGS SEPTIC SERVICE, INC.